The oral health status of senile dementia patients: a systematic review

doi:10.12016/j.issn.2096-1456.2019.07.009

Abstract

Abstract:

Objective To systematically evaluate the oral health status of senile dementia patients. Methods The CNKI, Wanfang, CBM, PubMed, Embase and Web of Science databases were searched online. Literature on the oral health status of Alzheimer′s patients published at home and abroad was collected. The search period extended to December 2018. Revman 5.3 software was used to perform the meta-analysis of homogeneous research. Results Ten studies satisfied the eligibility criteria. The meta-analysis revealed that older people with dementia had fewer remaining natural teeth [MD=-3.22 (95% CI -5.59, -0.85)] and more decayed missing filled teeth [MD=3.36 (95% CI 0.80, 5.92)] than the healthy control group (P < 0.05). The plaque index [MD=0.86 (95% CI 0.45, 1.28)], percentage bleeding on probing [MD=16.60 (95% CI 9.81, 23.39)], probing depth [MD=0.68 (95% CI 0.03, 1.34)], and clinical attachment loss [MD=1.13 (95% CI 0.38, 1.88)] were significantly higher in older people with dementia than in the healthy control group (P < 0.05). Conclusion The dental and periodontal health status of Alzheimer′s patients is worse than that of healthy controls. Thus, the former group needs special oral care and treatment.

Key words: dementia, older people, Alzheimer′s disease, oral health, periodontal disease, caries, Meta-analysis

摘要：

目的对老年痴呆患者的口腔健康状况进行系统评价。方法计算机检索CNKI、万方数据库、CBM、PubMed、EmBase、Web of Science数据库,收集国内外公开发表的研究老年痴呆患者口腔健康状况的观察性研究文献,检索时间截止至2018年12月。由2名研究者根据纳入与排除标准对相关文献进行筛选、质量评价和数据提取,对同质研究采用Revman 5.3软件进行Meta分析。结果最终纳入10个研究,Meta分析结果显示与对照组人群相比,老年痴呆患者龋失补牙数多[MD=3.36,95% CI（0.80,5.92）],而剩余天然牙数少[MD=-3.22,95% CI（-5.59,-0.85）];老年痴呆患者的菌斑指数[MD=0.86,95% CI（0.45,1.28）]、探诊出血阳性百分比[MD=16.60,95% CI（9.81,23.39）]、探诊深度[MD=0.68,95% CI（0.03,1.34）]及附着丧失[MD=1.13,95% CI（0.38,1.88）]均要高于健康对照组,所有参数差异均有统计学意义（P < 0.05）。结论老年痴呆患者牙体和牙周健康状况较健康对照人群差,需对这一人群进行特别的口腔护理和治疗。

关键词: 痴呆, 老年人, 阿尔茨海默病, 口腔健康, 牙周病, 龋病, Meta分析

CLC Number:

R781

Peng ZHOU,Jianping TAN,Dan WANG,Ming TANG. The oral health status of senile dementia patients: a systematic review[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2019, 27(7): 457-463.

周鹏,谭建苹,王丹,唐明. 老年痴呆患者口腔健康状况的系统评价[J]. 口腔疾病防治, 2019, 27(7): 457-463.

Figures/Tables 10

References 30

[1]	Prince M, Bryce R, Albanese E , et al. The global prevalence of dementia: a systematic review and meta analysis[J]. Alzheimers Dement, 2013,9(1):63-75. DOI URL
[2]	Alzheimer′s Association . 2016 Alzheimer′s disease facts and figures[J]. Alzheimers Dement, 2016,12(4):459-509. DOI URL
[3]	Gil-Montoya JA, Sanchez-Lara I, Carnero-Pardo C , et al. Is periodontitis a risk factor for cognitive impairment and dementia? A case-control study[J]. J Periodontol, 2015,86(2):244-253. DOI URL
[4]	Cicciù M, Matacena G, Signorino F , et al. Relationship between oral health and its impact on the quality life of Alzheimer′s disease patients: a supportive care trial[J]. Int J Clin Exp Med, 2013,6(9):766-772.
[5]	Ship JA, Decarli C, Friedland RP , et al. Diminished submandibular salivary flow in dementia of the Alzheimer type[J]. J Gerontol, 1990,45(2):61-66. DOI URL
[6]	Shetty SR, Bhowmick S, Castelino R , et al. Drug induced xerostomia in elderly individuals: an institutional study[J]. Contemp Clin Dent, 2012,3(2):173-175. DOI URL
[7]	Ribeiro GR, Costa J, Ambrosano G , et al. Oral health of the elderly with Alzheimer′s disease[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2012,114(3):338-343. DOI URL
[8]	Chu CH, Ng A, Chau AM , et al. Oral health status of elderly Chinese with dementia in Hong Kong[J]. Oral Health Prev Dent, 2015,13(1):51-57.
[9]	Cota GF, De Sousa MR, Fereguetti TO , et al. Efficacy of anti-leishmania therapy in visceral leishmaniasis among HIV infected patients: a systematic review with indirect comparison[J]. PLoS Negl Trop Dis, 2013,7(5):e2195. DOI URL
[10]	Stang A . Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol, 2010,25(9):603-605. DOI URL
[11]	Hu J, Dong Y, Chen X , et al. Prevalence of suicide attempts among Chinese adolescents: a meta-analysis of cross-sectional studies[J]. Compr Psychiatry, 2015,61:78-89. DOI URL
[12]	张冰, 康洁, 陈晓明 . Meta分析多亚组标准差合并方法探讨[J]. 中国循证医学杂志, 2016,16(7):851-854.
[13]	Higgins JP, Thompson SG . Quantifying heterogeneity in a meta-analysis[J]. Stat Med, 2002,21(11):1539-1558. DOI URL
[14]	Aragón F, Zea-Sevilla MA, Montero J , et al. Oral health in Alzheimer′s disease: a multicenter case-control study[J]. Clin Oral Investig, 2018,22(9):3061-3070. DOI
[15]	D'Alessandro G , Costi T, Alkhamis N, et al. Oral health status in Alzheimer′s disease patients: a descriptive study in an Italian population[J]. J Contemp Dent Pract, 2018,19(5):483-489. DOI URL
[16]	Ferreira RC, Duarte Vargas AM, Neves Fernandes NC , et al. Do elderly individuals with a cognitive handicap have worse oral health?[J]. Cien Saude Colet, 2014,19(8):3417-3428. DOI URL
[17]	Gil-Montoya JA, Sánchez LI, Carnero PC , et al. Oral hygiene in the elderly with different degrees of cognitive impairment and dementia[J]. J Am Geriatr Soc, 2017,65(3):642-647. DOI URL
[18]	Lee KH, Wu B, Plassman BL . Cognitive function and oral health-related quality of life in older adults[J]. J Am Geriatr Soc, 2013,61(9):1602-1607. DOI URL
[19]	Martande SS, Pradeep AR, Singh SP , et al. Periodontal health condition in patients with alzheimer′s disease[J]. Am J Alzheimers Dis Other Demen, 2014,29(6):498-502. DOI URL
[20]	Zenthöfer A, Baumgart D, Cabrera T , et al. Poor dental hygiene and periodontal health in nursing home residents with dementia: an observational study[J]. Odontology, 2017,105(2):208-213. DOI URL
[21]	Zenthoefer A, Schroeder J, Cabrera T , et al. Comparison of oral health among older people with and without dementia[J]. Community Dent Health, 2014,31(1):27-31.
[22]	热依拉·居热提, 魏奕茹, 何攀龙 , 等. 新疆汉维两民族阿尔茨海默病患者的牙周健康状况调查[J]. 重庆医科大学学报, 2016,41(12):1267-1271.
[23]	Ferrari Cestari JA, Campos Fabri GM, Kalil J , et al. Oral infections and cytokine levels in patients with alzheimer′s disease and mild cognitive impairment compared with controls[J]. J Alzheimers Dis, 2016,52(4):1479-1485. DOI URL
[24]	Maldonado A, Laugisch O, Burgin WA , et al. Clinical periodontal variables in patients with and without dementia--a systematic review and meta-analysis[J]. Clin Oral Investig, 2018,22(7):2463-2474. DOI
[25]	Machado MC, Lopes GH, Marchini L . Oral health of Alzheimer′s patients in Sao Jose dos Campos, Brazil[J]. Geriatr Gerontol Int, 2012,12(2):265-270. DOI URL
[26]	Fujihara I, Sadamori S, Abekura H , et al. Relationship between behavioral and psychological symptoms of dementia and oral health status in the elderly with vascular dementia[J]. Gerodontol, 2013,30(2):157-161. DOI URL
[27]	Hatipoglu MG, Kabay SC, Guven G . The clinical evaluation of the oral status in Alzheimer-type dementia patients[J]. Gerodontol, 2011,28(4):302-306. DOI URL
[28]	樊明文 . 牙体牙髓病学[M]. 4版. 北京: 人民卫生出版社, 2012: 30-31.
[29]	Animireddy D, Bekkem VR, Vallala P , et al. Evaluation of pH, buffering capacity, viscosity and flow rate levels of saliva in caries-free, minimal caries and nursing caries children: an in vivo study[J]. Contemp Clin Dent, 2014,5(3):324-328. DOI URL
[30]	孟焕新 . 牙周病学[M]. 4版. 北京: 人民卫生出版社, 2012: 90-91.

作者	年	国家	研究类型	样本量(女/男)		年龄(岁)		结局指标
作者	年	国家	研究类型	痴呆组	对照组	痴呆组	对照组	结局指标
Chu CH^[8]	2015	中国	病例对照研究	27/12	59	79.8 ± 7.4	≥60	DMFT、CPI
Aragón F^[14]	2018	西班牙	病例对照研究	38/32	23/13	77.4 ± 10.6	62.6 ± 7.1	DMFT、CPI、RNT
D'Alessandro G^[15]	2018	意大利	病例对照研究	83/37	60/43	79.1	77.68	RNT、CPI、GI
Ferreira RC^[16]	2014	巴西	横断面研究	131	501	65~74	65~74	DMFT、CPI、CAL
Gil-Montoya JA^[3,17]	2015 2017	西班牙	病例对照研究	240	324	78.25 ± 7.6	79.8 ± 8.3	PD、CAL、BOP%、PI、RNT
Lee KH^[18]	2013	美国	横断面研究	40/17	60/109	81.7 ± 6.9	77.4 ± 5.8	PI、PD
Martande SS^[19]	2014	印度	横断面研究	32/26	34/26	67.2 ± 7.3	64.5 ± 9.4	PI、GI、PD、CAL、BOP%
Zenth?fer A^[20,21]	2017 2015	德国	队列研究	89/47	61/22	84.6 ± 8.1	87.0 ± 9.8	BOP%、PCR、DHI、CPI、RNT
热依拉·居热提^[22]	2016	中国	横断面研究	62	63	65.2 ± 7.3	64.5 ± 9.4	PI、GI、PD、CAL、BOP、RNT
Cestari JAF^[23]	2016	巴西	病例对照研究	28/16	14/7	75.71 ± 6.70	75.33 ± 5.75	PD、CAL、PCR、BOP%

作者	年	国家	研究类型	样本量(女/男)		年龄(岁)		结局指标
作者	年	国家	研究类型	痴呆组	对照组	痴呆组	对照组	结局指标
Chu CH^[8]	2015	中国	病例对照研究	27/12	59	79.8 ± 7.4	≥60	DMFT、CPI
Aragón F^[14]	2018	西班牙	病例对照研究	38/32	23/13	77.4 ± 10.6	62.6 ± 7.1	DMFT、CPI、RNT
D'Alessandro G^[15]	2018	意大利	病例对照研究	83/37	60/43	79.1	77.68	RNT、CPI、GI
Ferreira RC^[16]	2014	巴西	横断面研究	131	501	65~74	65~74	DMFT、CPI、CAL
Gil-Montoya JA^[3,17]	2015 2017	西班牙	病例对照研究	240	324	78.25 ± 7.6	79.8 ± 8.3	PD、CAL、BOP%、PI、RNT
Lee KH^[18]	2013	美国	横断面研究	40/17	60/109	81.7 ± 6.9	77.4 ± 5.8	PI、PD
Martande SS^[19]	2014	印度	横断面研究	32/26	34/26	67.2 ± 7.3	64.5 ± 9.4	PI、GI、PD、CAL、BOP%
Zenth?fer A^[20,21]	2017 2015	德国	队列研究	89/47	61/22	84.6 ± 8.1	87.0 ± 9.8	BOP%、PCR、DHI、CPI、RNT
热依拉·居热提^[22]	2016	中国	横断面研究	62	63	65.2 ± 7.3	64.5 ± 9.4	PI、GI、PD、CAL、BOP、RNT
Cestari JAF^[23]	2016	巴西	病例对照研究	28/16	14/7	75.71 ± 6.70	75.33 ± 5.75	PD、CAL、PCR、BOP%

研究	A	B	C	D	E	F	G	H	I	总分
Chu CH 2015^[8]	0	1	0	1	1	1	1	1	0	6
Aragón F 2018^[14]	1	1	1	0	1	1	1	1	1	8
D′Alessandro G 2018^[15]	0	1	0	1	1	1	1	1	0	6
Gil-Montoya JA 2017^[3,17]	1	1	1	1	1	1	1	1	1	9
Cestari JAF 2016^[23]	1	0	1	1	1	1	1	1	1	8

研究	A	B	C	D	E	F	G	H	I	总分
Chu CH 2015^[8]	0	1	0	1	1	1	1	1	0	6
Aragón F 2018^[14]	1	1	1	0	1	1	1	1	1	8
D′Alessandro G 2018^[15]	0	1	0	1	1	1	1	1	0	6
Gil-Montoya JA 2017^[3,17]	1	1	1	1	1	1	1	1	1	9
Cestari JAF 2016^[23]	1	0	1	1	1	1	1	1	1	8

研究	a	b	c	d	e	f	g	h	j	k	总分
Ferreira RC 2014^[16]	1	1	1	1	1	1	1	0	0	1	8
Lee KH 2013^[18]	1	1	0	1	1	1	0	1	1	0	7
Martande SS 2014^[19]	1	1	1	1	1	1	0	1	0	1	8
Zenth?fer A 2017^[20,21]	1	1	1	1	0	1	1	1	0	1	8
热依拉·居热提 2016^[22]	1	1	1	1	1	1	0	1	0	1	8